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General NPI Number Information
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NPI Number | 1447147517
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Entity Type | Organization
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Legal Business Name | REDSTART PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 06/21/2025
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 600 PARK OFFICES DRIVE, STE 300 #4030
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City | DURHAM
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State | NC
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Zip | 27713-2887
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Country | US
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Telephone | 919-283-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 600 PARK OFFICES DRIVE, STE 300 #4030
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City | DURHAM
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State | NC
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Zip | 27713-2887
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | SHANNON BLAKEY
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Credential | PHD
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Telephone | 919-283-3698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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